The first choice of treatment for Achilles tendon problems (tendinopathy) is conservative. This includes a whole spectrum of treatments including physiotherapy, stretching and loading of the tendon/calf muscle, footwear adjustments, insoles, relative rest and time. If symptoms do not improve shock wave treatment will be indicated. Another option is a high volume injections but cortisone injections bear a risk of a rupture and need to be considered with caution. In case of no improvement, surgery can be considered. Depending on the severity of the tendinopathy a “debridement” of the tendon resection of the degenerate portion of the tendon might be sufficient. In severe cases, more invasive surgery might be needed but generally one can restore function and limit discomfort with the correct operation.
Ideally, patients should present at an early stage to prevent surgery and allow a quick recovery to resume normal walking and sports activities again.